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Relationship Between Concussion History and Concussion Knowledge, Attitudes, and Disclosure Behavior in High School Athletes

Register-Mihalik, Johna K. PhD, LAT, ATC*,†; Valovich McLeod, Tamara C. PhD, ATC, FNATA; Linnan, Laura A. ScD§; Guskiewicz, Kevin M. PhD, ATC, FNATA*,†; Marshall, Stephen W. PhD†,¶

Clinical Journal of Sport Medicine: May 2017 - Volume 27 - Issue 3 - p 321–324
doi: 10.1097/JSM.0000000000000349
Brief Report

Objective: Examine the association between self-reported concussion history and measures of concussion knowledge, attitude, and disclosure behavior.

Design: Cross-sectional survey.

Setting: Classroom.

Participants: A convenience sample of high school athletes (n = 167; mean age = 15.7 years) from multiple sports completed a validated survey.

Independent Variables: Concussion history (main predictor) was defined as the number of self-recalled concussions during participants' high school career.

Main Outcome Measures: The outcomes were recalled concussion disclosure behavior (3 measures) and scales assessing both concussion knowledge and concussion attitude.

Results: A greater number of previous concussions was associated with worse attitude to concussion and negative concussion disclosure behavior. For every 3 additional self-recalled concussions, there was a mean decrease of 7.2 points (range of possible scores = 14-98) in concussion attitude score (P = 0.002), a 48% decrease in the self-reported proportion of concussion events disclosed (P = 0.013), and an increased prevalence of self-reported participation in games (67%) and practices (125%) while experiencing signs and symptoms of concussion (P < 0.001). Increased concussion history did not affect concussion knowledge score (P = 0.333).

Conclusions: Negative trends in concussion disclosure behavior were identified in youth athletes with a positive history of concussion. Improving disclosure in this subgroup will require targeted efforts addressing negative attitude to concussion.

*Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;

Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;

Athletic Training Programs and School of Osteopathic Medicine, A.T. Still University, Mesa, Arizona;

Departments of §Health Behavior; and

Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

Corresponding Author: Johna K. Register-Mihalik, PhD, LAT, ATC, Matthew Gfeller Sport-Related TBI Research Center, 2207 Stallings-Evans Sports Medicine Center, Campus Box 8700, Chapel Hill, NC 27599-8700 (johnakay@email.unc.edu).

Funded in part by a NFL Charities Medical Research Grant. J.R.M. and S.W.M. are partially supported by an ICRC award (R49/CE002479) from the National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.

The authors report no conflicts of interest.

Received August 17, 2015

Accepted April 13, 2016

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